Endoscopic Treatment for Laterally Spreading Tumors in the Colon

Saito, Yutaka; Fujii, Takeshi; Kondo, Hisashi; Mukai, Hidekazu; Yokota, Takuya; Kozu, Teruo; Saito, Daizo

doi:10.1055/s-2001-16213

Cited by 160 publications

(144 citation statements)

References 5 publications

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“…Matsuda et al [29] , Watari et al [33] , 1998 Snare 186 Lateral spreading tumor EMR 12 Sugisaka et al [34] , 2003 Snare 162 No information EMR 13 Matsunaga et al [35] , 1999 Snare 134 No information EMR 14 Nomura et al [36] , 2001 Snare 54 No information EMR 15 Kobayashi et al [37] , 1999 Snare 131 No information EMR 16 Nakajima et al [38] , 2006 Snare 52 No information EMR 17 Cho et al [39] , 1999 Snare 34 No information EMR 18 Saito et al [40] , 2001 Snare 170 Lateral spreading tumor EMR 19 Tanaka et al [13] , 2001 Snare with needle spike 81 Lateral spreading tumor EMR 20 Ahmad et al [41] , 2002 Snare with suction 41 Colon and rectum EMR 21 Hurlstone et al [42] , to be between 7% and 34% for large sessile polyps [6,48] . Further more, our meta-analysis revealed that experience performing EMR plays an important role in achieving a better en-bloc resection and cure en-bloc tumorfree rate.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Puli¹,

Kakugawa²,

Gotoda³

et al. 2009

WJG

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AIM:To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection (EMR). METHODS:Studies using the EMR technique to resect large colorectal polyps were selected. Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection. Articles were searched for in Medline, Pubmed, and the Cochrane Control Trial Registry, among other sources. RESULTS:An initial search identified 2620 reference articles, from which 429 relevant articles were selected and reviewed. Data was extracted from 25 studies (n = 5221) which met the inclusion criteria. All the studies used snares to perform EMR. Pooled proportion of en-bloc resections using a random effect model was 62.85% (95% CI: 51.50-73.52). The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66% (95% CI: 47.14-69.71). With higher patient load (> 200 patients), this complete cure en-bloc resection rate improves from 44.19% (95% CI:24.31-65.09) to 69.17% (95% CI: 51.11-84.61). CONCLUSION:EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Puli¹,

Kakugawa²,

Gotoda³

et al. 2009

WJG

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“…Polypectomy is normally indicated for pedunculated or adenomatous semi-pedunculated polyps, while EMR is suitable for sessile, semi-pedunculated, or superficial tumors that are likely to be carcinoma [6,57]. ESD allows complete en bloc resection regardless of the size of the lesion [28,31,58,59]. Colorectal ESD is thus indicated for lesions requiring endoscopic en bloc resection when it is difficult to use the snare technique [31].…”

Section: Commentmentioning

confidence: 99%

“…Most LST-Gs are considered adenomatous lesions. Among homogenous-type LST-Gs, the incidence of carcinoma or submucosal invasion is extremely low [28,29]. Large nodule in a nodular mixedtype LST-G, where submucosal invasion tends to be present [30], should be resected en bloc [31].…”

Section: Cq What Therapy Is Indicated For Laterally Spreading Tumorsmentioning

confidence: 99%

Evidence-based clinical practice guidelines for management of colorectal polyps

et al. 2015

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Background Recently in Japan, the morbidity of colorectal polyp has been increasing. As a result, a large number of cases of colorectal polyps that are diagnosed and treated using colonoscopy has now increased, and clinical guidelines are needed for endoscopic management and surveillance after treatment. Methods Three committees [the professional committee for making clinical questions (CQs) and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators] were organized. Ten specialists for colorectal polyp management extracted the specific clinical statements from articles published between 1983 and September 2011 obtained from PubMed and a secondary database, and developed the CQs and statements. Basically, statements were made according to the GRADE system. The expert panel individually rated the clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than seven on a nine-point scale from the panel was regarded as valid. Results The professional committee created 91CQs and statements for the current concept and diagnosis/treatment of various colorectal polyps including epidemiology, screening, pathophysiology, definition and classification, diagnosis, treatment/management, practical treatment, complications and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumor/carcinoma). Conclusions After evaluation by the moderators, evidence-based clinical guidelines for management of colorectal polyps have been proposed for 2014.

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“…For en bloc resection of flat lesions larger than 20 mm, conventional EMR is inadequate because of incomplete removal and frequent local recurrence. When analyzing the endoscopic features of 257 LSTs in order to assess which features correlated with the depth of invasion, unevenness of nodules, presence of large nodules, size, histological type, and presence of depression in the tumor were significantly associated with the depth of invasion [41] . In addition, LST-NG showed a higher frequency of sm invasion than LST-G (14% vs 7%) [42] .…”

Section: Endoscopic Resection Of Colorectal Tumorsmentioning

confidence: 99%

“…This supports the therapeutic effectiveness of endoscopic removal of polyps and flat lesions that are confined to the mucosa, regardless of their size. On the other hand, colorectal laterally spreading tumor (LST) classified as granular (LST-G) and non granular type (LST-NG), are defined as lesions larger than 10 mm in diameter, with a low vertical axis, extending along the luminal wall [41] . For en bloc resection of flat lesions larger than 20 mm, conventional EMR is inadequate because of incomplete removal and frequent local recurrence.…”

Section: Endoscopic Resection Of Colorectal Tumorsmentioning

confidence: 99%

Endoscopic resection of superficial gastrointestinal tumors

Giovannini

Lopes²

2008

WJG

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Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract.

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Endoscopic Treatment for Laterally Spreading Tumors in the Colon

Abstract: When LSTs meet the above endoscopic criteria, EMR should be the first-line treatment because of the low risk of massive submucosal invasion.

Cited by 160 publications

References 5 publications

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

Evidence-based clinical practice guidelines for management of colorectal polyps

Endoscopic resection of superficial gastrointestinal tumors

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